Readiness Check

1. What are you hoping to improve with ketamine therapy?

Depression or low mood
Anxiety or stress
PTSD or trauma symptoms
Chronic pain or other condition

2. What best describes your past treatment experience?

I’ve tried therapy and medication, but they haven’t worked well
I’ve tried some treatments with mild results
I’m new to mental health treatment
I’m just exploring my options right now

3. Do you have any of the following medical conditions?

Uncontrolled high blood pressure
Seizure disorder
History of psychosis or schizophrenia
None of the above

4. Are you currently taking any medications or substances?

Prescription medications
Recreational drugs or alcohol
Both of the above
None

5. Have you ever been diagnosed with a serious medical condition?

Heart problems
Liver or kidney issues
Other chronic health condition
No, I’m generally healthy

6. How open are you to follow-up therapy or integration after sessions?

Very open — I want to combine therapy with ketamine
Somewhat open — I’d consider it if recommended
Unsure — I don’t know much about it
Not interested in follow-up therapy

Ketamine Therapy Readiness Check